An anterior approach to spinal pathology of the upper thoracic spine through a partial manubriotomy

Lam, Fred C.; Groff, Michael W.

doi:10.3171/2011.6.spine11189

Cited by 17 publications

(14 citation statements)

References 22 publications

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“…Zeng et al compared the clinical curative effect of cervicothoracic spinal tuberculosis by anterior, anterior-posterior, and posterior approaches, and they found that the postoperative local recurrent deformity rate for the simple anterior approach was highest [ 5 ]. However, other studies have confirmed the curative effect of the anterior approach in cervicothoracic disease, especially in spinal tuberculosis [ 9 – 11 ]. The posterior approach to the cervicothoracic junction is disadvantageous because of the destabilization effect, inadequate visualization of the pathology, and need for a long posterior construct to restore stability.…”

Section: Discussionmentioning

confidence: 99%

Surgical approach and management outcomes for junction tuberculous spondylitis: a retrospective study of 77 patients

et al. 2018

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BackgroundJunction tuberculous spondylitis involves the stress transition zone of the spine and has a high risk of progression to kyphosis or paraplegia. Problems still exist with treatment for spinal junction tuberculosis. This study investigated the surgical approach and clinical outcomes of junction spinal tuberculosis.MethodsFrom June 1998 to July 2014, 77 patients with tuberculous spondylitis were enrolled. All patients received 2–3 weeks of anti-tuberculous treatment preoperatively; treatment was prolonged for 2–3 months when active pulmonary tuberculosis was present. The patients underwent anterior debridement and were followed up for an average of 29.4 months clinically and radiologically.ResultsThe cervicothoracic junction spine (C7-T3) was involved in 15 patients. The thoracolumbar junction spine (T11-L2) was involved in 39 patients. The lumbosacral junction spine (L4-S1) was involved in 23 patients. Two patients with recurrence underwent reoperation; the drugs were adjusted, and all patients achieved bone fusion. The preoperative cervicothoracic and thoracolumbar kyphosis angle and lumbosacral angle were 31.4 ± 10.9°, 32.9 ± 9.2°, and 19.3 ± 3.7°, respectively, and the corresponding postoperative angles were ameliorated significantly to 9.1 ± 3.2°, 8.5 ± 2.9°, and 30.3 ± 2.8°. The preoperative ESR and C-reactive protein level of all patients were 48.1 ± 11.3 mm/h and 65.5 ± 16.2 mg/L which decreased to 12.3 ± 4.3 mm/h and 8.6 ± 3.7 mg/L at the final follow-up, respectively. All patients that had neurological symptoms achieved function status improvement at different degrees.ConclusionFor spinal tuberculosis of spinal junctions, anterior debridement, internal fixation, and fusion can be preferred and achieved. If multiple segment lesions are too long or difficult for operation of anterior internal fixation, combining posterior pedicle screw fixation is appropriate.

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Section: Discussionmentioning

confidence: 99%

Surgical approach and management outcomes for junction tuberculous spondylitis: a retrospective study of 77 patients

et al. 2018

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“…show that we can comfortably place a 2-level strut graft or intervertebral device, an anterior plate, and screw at T1 and down to T5, but other approaches to the levels cannot been able to secure an anterior plate in the patient below T3 as in technical notes of Fred et al 2011 [9]. Thus, careful pre-operative planning needs to be performed in selecting lesions that can be accesses safely using our approach.…”

Section: Discussionmentioning

confidence: 94%

Mini Thoracotomy Approach to Upper Thoracic Spine

Hendam¹,

El-Samouly²,

Behairy³

et al. 2018

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Upper thoracic spine lesions are characterized by delayed diagnosis due to nonspecific symptoms and its anterior aspect (T1 -T4) is difficult to be approached surgically. This retrospective clinical study was done to assess the efficacy of mini thoracotomy approach in management of these lesions. We studied 14 cases with upper thoracic spine different pathological lesions at levels (T1 -T4). These lesions were indicated for anterior approach surgery. Radiological assessment included plain X-ray, MRI and CT scan thoracic spine. The anaesthesia was specifically selective intubation and unilateral ventilation. All patients were operated upon through mini inter-costal thoracotomy approach (left sided in 13 patients and right sided in 1patient). Out of 14 patients there were 7 males and 7 females. The age range was 20 -55 years (mean 38.7 years). Preoperative symptoms included vague nonspecific upper thoracic pain in 11 patients, lower limbs weakness in 6 patients, sphincteric disturbance in 5 patients, upper thoracic kyphotic deformity in 4 patients, severe brachialgia in 3 patients and neck pain in 2 cases. The operative time was ranged from 90 -210 minutes (mean 152 m). Blood loss ranged from 250 to 750 cc (mean 464 cc). Chest tube drainage was inserted in all patients. There were no intra-operative or post-operative surgically related complications and no patients needed ICU admission. The lesions were neoplasms in 8 patients, traumatic fracture dislocation in 3 cases, tuberculous spondylodiscitis in 2 cases and degenerative disc prolapse in 1 case. All patients improved post-operative as regard their pre-operative complaints except one patient. During the follow up period, no mortality was recorded. In conclusion, mini thoracotomy approach seems to be ideal only for patients with mono-or bi-segmental pathology involving the upper thoracic spine.

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“…Many approaches have been described in the literature, including both anterior and posterior routes [ 17 ]. The posterior transpedicular approach or laminectomy has limited access and does not allow direct visualization of ventral lesions [ 18 ]. Approaches such as costotransversectomy or the lateral extracavitary approach are difficult above the T4 vertebra because of the scapula [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

The Transaxillary Approach as a Direct Route in the Management of Upper Thoracic Spine Pathology: A Technical Note with Case Series

Ifthekar,

Seuk,

Hwang

et al. 2024

Asian Spine J

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This retrospective case series of prospective data aims to describe the transaxillary approach for the treatment of upper thoracic spine pathology. Various surgical techniques and approaches have been reported across the literature to address upper thoracic spine pathology, including the cervicothoracic approach, anterior transsternal approach, posterolateral approach, supraclavicular approach, and lateral parascapular approaches. These techniques are invasive. A minimally invasive, less morbid, and direct access approach to the pathology of the upper thoracic spine has not been reported in the literature. Patients with pathology affecting the first thoracic vertebra up to the sixth thoracic vertebra were classified into the upper thoracic spine group. Patients with pathology below the sixth thoracic vertebra were excluded. Patients not having a minimum follow-up of 12 months were also excluded. The study analyzed 18 patients. The mean preoperative modified Japanese Orthopedic Association score was 7.2±1.44, which improved to 10.16±1.2 (p<0.05). The majority (14/18) of the patients had an excellent outcome. Three patients had good outcomes, and one patient had a fair outcome. Five cases of intraoperative dural leak were recorded, and one patient had postoperative neurological deficit. The transaxillary approach is a safe, viable, muscle-sparing, and minimally invasive approach for ventral pathologies of the upper thoracic spine.

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An anterior approach to spinal pathology of the upper thoracic spine through a partial manubriotomy

Cited by 17 publications

References 22 publications

Surgical approach and management outcomes for junction tuberculous spondylitis: a retrospective study of 77 patients

Surgical approach and management outcomes for junction tuberculous spondylitis: a retrospective study of 77 patients

Mini Thoracotomy Approach to Upper Thoracic Spine

The Transaxillary Approach as a Direct Route in the Management of Upper Thoracic Spine Pathology: A Technical Note with Case Series

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